Evaluation of an Electronic Central Referral Intake System and the Development of a CMS User Reference Manual for Nova Scotia Hearing and Speech Centres

Abstract

1.0 Executive Summary 1.1 Scope The CMS User Reference Manual project and the Electronic Central Referral Intake System Feasibility Report project will ultimately extend to all Nova Scotia Hearing and Speech Centers within the province of Nova Scotia. While the research will primarily be conducted within HRM with additional support and input from the NSHSC site in Sydney Mines, Cape Breton, the proposed electronic referral system (eReferral) and CMS User Reference manual will apply to all NSHSC sites within Nova Scotia. The eReferral strategy will affect incoming referrals, triage, pre-registering and the allocation of referrals within each individual NSHSC site. The CMS User Reference Manual will aid all personnel who require instructions pertaining to activities performed within Nightingale On Demand Version 8.9. 1.2 Purpose The purpose of the Database/Technology Design Student at Nova Scotia Hearing and Speech Centers was to gain valuable insight and experience in a healthcare setting while building on professional workplace skills. Throughout the internship period the author was tasked to complete two projects in order to correct various errors within the organization. These two projects were the CMS User Reference Manual and the Electronic Central Referral Intake System Feasibility Report. The CMS User Reference Manual was severely outdated and did not provide accurate guidance or instructions to personnel using Nightingale On Demand. The purpose of updating the manual was to provide staff members with an accurate guide in order to navigate Nightingale On Demand. While mainly for new staff for learning purposes, the manual is also for existing staff requiring updates on new software features or reminders on how to complete various activities within the system. Once completed, staff members can rely on an updated, accurate, and detailed description on how to complete daily clinical activities using Nightingale On Demand. The investigation into the feasibility of implementing an eReferral system for Nova Scotia Hearing and Speech Centres was conducted to reduce variance in the clinical pathway and increase patient access. Many patient referrals were becoming lost before they were pre-registered erasing any evidence of the referral from the NSHSC office. This resulted in referred patients not receiving the treatment they require. The purpose of the Electronic Central Referral Intake System Feasibility Report was to examine NSHSC and determine if an electronic referral system would benefit and function efficiently within the workflow while reducing the variance in the clinical pathway. 1.3 Findings The findings of the investigation regarding the feasibility of an electronic referral system for NSHSC resulted from extensive interviews with staff and additional research. The interviewees disclosed the flow of information regarding the referral process, more specifically, how a referral sent in by a patient moves through the system and receives services from NSHSC. Additionally, decision points and workplace practices regarding the referral process were discussed. Examining the flow of information, typical referral procedures, and decisions resulted in identifying a number of errors that contribute to misplaced referrals. Periodically pre-registering referrals, lack of standardized 5 procedures, referral storage methods, number of consultations for referrals, and the standard format of the referral which is a paper hard copy are all influences that contribute to misplaced patient referrals. In order to mitigate the volume of misplaced referrals due to these errors, a solution was developed as discussed in section 1.4 Analysis, an electronic referral system. 1.4 Analysis The investigative work regarding the referral process led to the identification of various errors contributing to misplaced referrals. The responding solution that remedied these errors was an eReferral system. Further analysis was conducted into the feasibility of NSHSC adopting such technology and whether it would function efficiently in the workplace. The investigation resulted in the eReferral system being a feasible option for NSHSC. The eReferral system requires the activation of two policies that are currently in development at NSHSC. The first policy is that the Administrative Support Professional (ASP) is trained to triage the majority of referrals without consultation. The second policy is that the ASP is to pre-register referrals within one day of receiving them. These are two vital practices that support the adoption of the eReferral system. The eReferral system can be integrated into the existing flow of information at NSHSC without causing any major disruptions to personnel. This encourages the adoption of such technology, eases the transition, and ultimately contributes to the feasibility of implementing the system. While these contributions to the feasibility are technology independent, the technology must be accessible for the system to exist. These technological requirements include an electronic referral form, an eReferral database, and an interface within Nightingale On Demand. The technological requirements have confirmed to be an option for use in the eReferral system by the developers of Nightingale On Demand and therefore contribute to the overall feasibility. With many of the barriers surpassed, the author can conclude that adopting an eReferral system is a feasible option for NSHSC and it will reduce the current variance seen in the clinical pathway resulting in reduced patient access.